Extracorporeal myoglobin elimination using the adsorber CytoSorb or the high-flux HF80 dialyzer for patients with...

Critically ill patients are frequently affected by severe rhabdomyolysis, consequently requiring renal replacement therapy (RRT). We asked whether CytoSorb is more potent than continuous veno-venous hemodiafiltration (CVVHDF) with the high-flux HF80 dialyzer in removing myoglobin and improving outcome for patients with rhabdomyolysis accompanied by acute kidney injury (AKI).

The historical HF80 cohort consisted of 97 patients who underwent CVVHDF with the HF80 dialyzer between 2010 and 2016. The CytoSorb cohort consisted of 102 patients who underwent treatment with CytoSorb in combination with CVVHDF with the standard high-flux F60S dialyzer between 2018 and 2023.

Patients treated with the HF80 dialyzer achieved a median relative reduction of myoglobin of 39% after 24 h of treatment and of 69% after 3 days of treatment; this reduction was similar to the median relative myoglobin elimination achieved for the CytoSorb group (40% after 24 h and 60% after 3 days). The proportions of patients in whom return of diuresis occurred were comparable between the two extracorporeal treatments. The groups did not differ significantly in in-hospital mortality rates. The decrease in the Sequential Organ Failure Assessment (SOFA) and Simplified Acute Physiology Score II (SAPS II) scores at the end of therapy was more pronounced in the CytoSorb group (SOFA P  < .0001; SAPS II P  < .0001) than in the HF80 group (SOFA P  = .004; SAPS II P  = .03). The frequency of new-onset end-stage kidney disease among survivors was similar in both groups.

Our analysis showed that using CytoSorb resulted in myoglobin reduction rates and clinical outcomes similar to those achieved with CVVHDF with the high-flux HF80 dialyzer for patients with rhabdomyolysis and AKI.